RESUMEN
The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) per 1000 patient-days increased in 2020 and this finding had a strong positive correlation with the incidence density of COVID-19 by the Spearman test. Polymyxin consumption also increased in 2020 but without significant correlation with CRAB or COVID-19 incidence density, presumably due to empirical and untargeted prescribing as a consequence of concern about CRAB infections. These findings are a warning to infection control programmes and antimicrobial stewardship.
Asunto(s)
Acinetobacter baumannii , Antiinfecciosos , COVID-19 , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Carbapenémicos , Atención a la Salud , Farmacorresistencia Bacteriana , Bacterias Gramnegativas , Humanos , Pruebas de Sensibilidad Microbiana , SARS-CoV-2RESUMEN
Body fat distribution predicts cardiovascular events better than body-mass index (BMI). Waist circumference (WC) and neck circumference (NC) are inexpensive anthropometric measurements. We aimed to present the conditional distribution of WC and NC values according to BMI, stratified by age and sex, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data. We analyzed 15,085 ELSA-Brasil participants with complete data. We used spline quantile regression models, stratified by sex and age, to estimate the NC and WC quantiles according to BMI. To test a putative association between age and median NC or WC values, we built sex-specific median regression models using both BMI and age as explanatory variables. We present estimated 25th, 50th, 75th, and 90th percentiles for NC and WC values, according to BMI, age, and sex. Predicted interquartile intervals for NC values varied from 1.6 to 3.8 cm and, for WC values, from 5.1 to 10.3 cm. Median NC was not associated with age in men (P=0.11) nor in women (P=0.79). However, median WC increased with advancing age in both sexes (P<0.001 for both). There was significant dispersion in WC and NC values for a given BMI and age strata for both men and women. WC, but not NC values, were associated with increasing age. The smaller influence of advancing age on the relationship between BMI and NC (compared to WC) values may be useful in longitudinal studies.
Asunto(s)
Cuello , Adulto , Anciano , Índice de Masa Corporal , Brasil , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Factores de Riesgo , Circunferencia de la CinturaRESUMEN
INTRODUÇÃO: A correção da estenose aórtica (EAo) por meio do implante por cateter de prótese aórtica (TAVI) tem sido cada vez mais realizada. No planejamento do procedimento, devem ser cuidadosamente avaliados fatores que influenciam o prognóstico, dentre estes, o grau de repercussão cardíaca estrutural e funcional secundário a EAo, por vezes inclusive com valvopatias concomitantes como insuficiência mitral e tricúspide (IT). A IT está presente em até 10% dos pacientes com EAo e estudos indicam mortalidade maior neste subgrupo. Entretanto, permanece incerto o verdadeiro papel da IT na evolução dos pacientes submetidos ao TAVI. O objetivo dessa revisão sistemática e metanálise é sintetizar e quantificar as evidências científicas disponíveis sobre o impacto da IT pré-procedimento na mortalidade a curto e longo-prazo de pacientes submetidos ao TAVI. MÉTODOS: De acordo com as recomendações PRISMA e MOO SE, foram pesquisados artigos originais, publicados até abril de 2019, em várias bases (MEDLINE/PubMed, SCOPUS, EMBASE, LILACS e Web of Science), que tenham reportado o grau de IT pré TAVI por meio de ecocardiograma, além da mortalidade por qualquer causa. Metanálises foram realizadas de acordo com a estratificação por tempo de follow-up, utilizando modelos de efeito fixo e random. A heterogeneidade entre os estudos foi avaliada pelo I2. RESULTADOS: Dos 301 encontrados, 16 estudos foram incluídos na revisão sistemática e 14 estudos na metanálise (> 31. 500 participantes). Pacientes com IT de grau moderado ou grave pré-TAVI apresentam mortalidade por qualquer causa significativamente maior do que aqueles com IT ausente ou de grau leve, tanto em até 30 dias (HR 1. 70; IC 95%1. 09-2. 66) quanto em seguimento longo (média de 1,4 ano) (HR 95% 1. 63; IC 1. 32-2. 03). Esse efeito foi homogêneo em ambos os subgrupos de follow-up (I2 = 42. 1% e 41. 4%, com p valores de 0,159 e 0,082, respectivamente). CONCLUSÃO: Existe evidência sugestiva de que maiores graus de IT estão associados a pior prognóstico em pacientes que serão submetidos ao TAVI. Assim, a avaliação criteriosa da valva tricúspide deve ser considerada no planejamento pré-TAVI, tanto para indicação precisa do melhor momento de correção da EAo, quanto para redefinir estratégias para o manejo de pacientes que sabidamente apresentam pior evolução. Figura 1 Metanálise para mortalidade a curto-prazo (follow-up até 30 dias). Figura 2 Metanálise para mortalidade a longo-prazo (follow-up médio 1,4 ano).
Asunto(s)
Pronóstico , Insuficiencia de la Válvula Tricúspide , Reemplazo de la Válvula Aórtica TranscatéterRESUMEN
Body fat distribution predicts cardiovascular events better than body-mass index (BMI). Waist circumference (WC) and neck circumference (NC) are inexpensive anthropometric measurements. We aimed to present the conditional distribution of WC and NC values according to BMI, stratified by age and sex, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data. We analyzed 15,085 ELSA-Brasil participants with complete data. We used spline quantile regression models, stratified by sex and age, to estimate the NC and WC quantiles according to BMI. To test a putative association between age and median NC or WC values, we built sex-specific median regression models using both BMI and age as explanatory variables. We present estimated 25th, 50th, 75th, and 90th percentiles for NC and WC values, according to BMI, age, and sex. Predicted interquartile intervals for NC values varied from 1.6 to 3.8 cm and, for WC values, from 5.1 to 10.3 cm. Median NC was not associated with age in men (P=0.11) nor in women (P=0.79). However, median WC increased with advancing age in both sexes (P<0.001 for both). There was significant dispersion in WC and NC values for a given BMI and age strata for both men and women. WC, but not NC values, were associated with increasing age. The smaller influence of advancing age on the relationship between BMI and NC (compared to WC) values may be useful in longitudinal studies.
Asunto(s)
Cuello , Brasil , Índice de Masa Corporal , Factores de Riesgo , Estudios Longitudinales , Circunferencia de la CinturaRESUMEN
Idiopathic Spinal Cord Herniation (ISCH) is considered to be a rare cause of Thoracic Myelopathy. It is secondary to the gliding of the Spinal Cord through an anterior dural defect, without a completely defined cause. We present a case of ISCH which, even though was in its usual location, developed in a woman at a younger age than expected. The patient was 20 years old when diagnosed with Brown-Séquard Syndrome. MRI showed herniation at T4-T5 level, which was corrected using a posterior approach to expose the dural defect, reduce the herniation and place a heterologous graft. Postoperatively, neurological function improved, and adequate reduction was seen on imaging. Given the reports of recurrence and deterioration that have been seen after 18 months, follow-up was prolonged for a total of 2 years. We consider postoperative MRI performance important to establish the degree of reduction and alignment of the Spinal Cord.
Asunto(s)
Síndrome de Brown-Séquard/diagnóstico , Hernia/diagnóstico por imagen , Enfermedades de la Médula Espinal/diagnóstico , Médula Espinal/patología , Femenino , Herniorrafia/métodos , Humanos , Laminectomía/métodos , Imagen por Resonancia Magnética , Enfermedades Raras , Enfermedades de la Médula Espinal/fisiopatología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND AIMS: It is uncertain whether neck circumference can be a risk indicator for subclinical atherosclerosis. We aimed to investigate their relationships measured by coronary artery calcium (CAC) and common carotid intima-media thickness (cc-IMT) with neck circumference in ELSA-Brasil. METHODS AND RESULTS: In cross-sectional and sex-specific analyses of 2266 women (50.6 ± 8.4 yrs) and 1886 men (50.7 ± 9.0 yrs) with both cc-IMT and CAC, free from previous cardiovascular disease at baseline, we built logistic models using diverse cut-off points for CAC score (0 vs > 0, < 100 vs ≥ 100, < 400 vs ≥ 400 Agatston units) and cc-IMT (< 75 th percentile vs ≥ 75 th; <90th percentile vs ≥ 90 th) as dependent variables, after which adjustments for age and traditional cardiovascular risk factors were made. Mean neck circumference was 33.6 (± 2.4 cm) for women and 38.8 (± 2.6 cm) for men. In fully adjusted models including sociodemographic, cardiovascular risk factors and body-mass index and waist circumference, for each 1 standard deviation increase in neck circumference we found an odds ratio (OR, 95% CI) for IMT above the 75th percentile of (1.52, 1.16; 1.99) for women and (1.66, 1.28; 2.14) for men, and above the 90th cc-IMT percentile [1.66 (1.19; 2.32) for men but not for women [1.21 (0.80; 1.82)]. We found no association between neck circumference and CAC using different cut-off points (p > 0.05 for all). CONCLUSION: Neck circumference was significantly and independently associated with cc-IMT but not with CAC in women and men, indicating a possible effect of perivascular fat tissue on atherosclerosis.
Asunto(s)
Calcinosis/diagnóstico por imagen , Calcio/metabolismo , Grosor Intima-Media Carotídeo , Cuello/anatomía & histología , Adulto , Anciano , Índice de Masa Corporal , Brasil , Enfermedades Cardiovasculares/diagnóstico por imagen , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Estudios Transversales , Ejercicio Físico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Triglicéridos/sangre , Circunferencia de la CinturaRESUMEN
For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.
Asunto(s)
Programas Nacionales de Salud , Enfermedades Respiratorias/prevención & control , Organización Mundial de la Salud , Enfermedad Crónica , Política de Salud , Humanos , Enfermedades Respiratorias/patología , TurquíaRESUMEN
A 32 year-old woman with full-term pregnancy and a history of Ehlers-Danlos syndrome type II underwent cesarean delivery owing to breech presentation and the presence of oligohydramnios. Anesthesia was provided with a subarachnoid block with 6.5 mg of bupivacaine and 32.5 microg of fentanyl to T4. Depth of anesthesia was adequate and hemodynamic stability was good. The intervention was uneventful and the outcomes were excellent for both mother and fetus. A subarachnoid block with low doses of local anesthetic and fentanyl is an appropriate, safe alternative to general anesthesia for cesarean section in women with Ehlers-Danlos who have normal coagulation tests and no history of bleeding.
Asunto(s)
Anestesia Obstétrica , Anestesia Raquidea , Cesárea , Síndrome de Ehlers-Danlos , Complicaciones Cardiovasculares del Embarazo , Complicaciones Hematológicas del Embarazo , Adulto , Femenino , Humanos , EmbarazoRESUMEN
En este artículo hablamos del síndrome de Sjögren, enfermedad autoinmune de etiología desconocida que cursa con una clínica muy diversa y que no tiene tratamiento específico, sólo sintomático. Presentamos el caso de una paciente gestante con esta enfermedad que le fue diagnosticada en la infancia y que tuvo un embarazo que cursó sin mayores complicaciones. La clínica preexistente no se exacerbó en el curso del embarazo y la enfermedad no influyó en el desarrollo de la gestación (AU)
Asunto(s)
Adulto , Embarazo , Femenino , Humanos , Síndrome de Sjögren/diagnóstico , Complicaciones del Embarazo/diagnóstico , Síndrome de Sjögren/tratamiento farmacológico , Aspirina/uso terapéuticoRESUMEN
We present the clinical case of a 36 year old woman who had a previous kidney transplant with a spontaneous twin pregnancy and bilateral reflux. The pregnancy progressed without complications until the appearance of a severe foetal growth retardation which required ending the pregnancy. We present this case and make a review of renal transplant and gestation (AU)
Asunto(s)
Humanos , Femenino , Adulto , Insuficiencia Renal Crónica/complicaciones , Trasplante de Riñón , Complicaciones del Embarazo/cirugía , Embarazo Gemelar , Resultado del EmbarazoRESUMEN
La listeriosis es una infección infrecuente. Se contagia a través de los alimentos infectados por la Listeria monocytogenes, que típicamente tiene predilección por mujeres gestantes, inmunodeprimidos, ancianos y niños. Teniendo gran variedad de manifestaciones clínicas, cuyas complicaciones para la madre y el feto son graves, pudiendo complicar un embarazo con abortos, muerte fetal anteparto, parto pretérmino y con listeriosis neonatal. En este artículo describimos un caso de listeriosis neonatal y una revisión de la bibliografía actual (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Listeriosis/complicaciones , Complicaciones Infecciosas del Embarazo/diagnóstico , Listeria monocytogenes/patogenicidad , CesáreaRESUMEN
Cutaneous melanoma has received substantial attention during the last years because of the increase in its incidence which has been registered in many countries. This paper aims at describing the incidence and characteristics of all new cutaneous malignant melanoma cases during 1985-1992 reported to the Granada Cancer Registry (Spain) in the context of Mediterranean populations. A population-based study with 247 cutaneous melanoma cases was carried out. The variables used were: sex, age, anatomic site, hystological type, level of invasion and tumour thickness. The Age-Standardised incidence Rate per World population (ASRW) was 2.9 for males and 3.7 for females in the whole period. An increasing incidence trend for both males and females was found. The ASRW in 1985-1987, 1988-1990 and 1991-1992 was respectively 2.2, 2.9 and 3.2 for males and 3, 3.4, 4.7 for females. The most frequent location was trunk for males (36%) and lower extremities for females (44%). The most frequent hystological type for both males and females was superficial spreading melanoma. Seventy-six percent of males and 60% of females were diagnosed Clark's level III or over. Average tumour thickness was 3.3 mm for males and 2.4 mm for females. The results of this study can be a guidance for the setting up of health policies which would contribute to the prevention of the disease and to an improvement in care. Because of the increase in incidence rates and the high percentage of cases which were diagnosed at advanced stages, it is advised that prevention campaigns are addressed to the Granada population.
Asunto(s)
Melanoma/patología , Neoplasias Cutáneas/patología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Extremidades/irrigación sanguínea , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Vigilancia de la Población , Índice de Severidad de la Enfermedad , Factores Sexuales , España/epidemiologíaRESUMEN
BACKGROUND: Clinical observation ratifies the existence of commonly accepted erroneous beliefs (EB) in relation to sexuality. In the health care sector, reinforcing factors of these beliefs are the professionals who are not specifically trained to manage, or detect the same in addition to the variability of the criteria available on sexual health care. METHODS: The EB on sexuality were studied in 260 individuals (14-18 years) who are users of primary health care services. Four consultation offices of General Medicine were randomly selected, one by health care center (Area 20, Valencian Community, Spain). Subsequently, a structured interview was given to the users of these consultations over the period of one day. The interviews were carried out after receiving consent and guarantee of confidentiality. On the other hand, the results were compared with those previously obtained from the 44 health care professionals (HCP). The results are reported, the proportions compared (chi-square) to determine differences according to age, sex and level of education and the odds ratio was calculated to determine the probability of participation in EB according to sex. The response rate in users was 97.4% and is HCP 58%. RESULTS: The proportion of EB ranged from 16.9% who believed coitus as the only "normal" sexual relationship and 63.8% who believed in the existence of two types of female orgasm. Depending on the beliefs, statistically significant differences were observed according to age (from p = 0.03 to p < 0.0000) and the level of education (from p = 0.01 to p < 0.0000) and between the user adult population and the HCP (from p = 0.01 to p < 0.0000). CONCLUSIONS: There are numerous erroneous beliefs regarding sexuality in both primary health care users and, to a lesser extent, Spanish health care professionals. The influence of moral criteria, centered on reproduction, and prevalent sociocultural norms and values is of note. It was found that erroneous beliefs do not decrease with the educational level, but rather, change.
Asunto(s)
Actitud , Conducta Sexual , Adolescente , Adulto , Factores de Edad , Actitud del Personal de Salud , Educación , Femenino , Personal de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Principios Morales , Oportunidad Relativa , Factores SexualesRESUMEN
Las infecciones virales están involucradas en la patogénesis del asma y hay una estrecha relación entre infecciones respiratorias superiores (IRS), presumiblemente de origen viral y obstrucción bronquial. Sin embargo, en muchas de las IRS no es posible establecer la etiología viral, la cual podría deberse a limitaciones técnicas o a la implicación de otros causales, a pesar de un cuadro clínico similar (por ejemplo: aire frío). Por otra parte se carece de un acuerdo general sobre la definición de asma y diferentes criterios empleados con respecto a este tema. Principalmente en niños, los estertores audibles espontáneos, la disnea y los sonidos torácicos detectados mediante el uso de estetoscopio no deben ser interpretados necesariamente como la misma cosa. La prevalencia y la incidencia de la obstrucción bronquial inducida por virus alcanza de 11 a 42%, pero en ataques clásicos la prevalencia es menor. Varias mecanismos se encuentran involucrados en el asma inducida por virus; tal como la disfunción beta-adrenérgica, la hiperactividad colinérgica, la liberación aumentada de mediadores basofílicos, etcétera. Los virus pueden conducir a reacciones asmáticas de fase tardía y provocan un aumento de IgE específica contra el virus en secreción nasofaríngea de niños con obstrucción bronquial.
Asunto(s)
Humanos , Asma/epidemiología , Asma/fisiopatología , Infecciones del Sistema Respiratorio , VirusRESUMEN
Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores (AU)
Asunto(s)
Humanos , Insuficiencia Multiorgánica/diagnóstico , Índice de Severidad de la Enfermedad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermedad Crítica/mortalidad , Argentina , Estudios Multicéntricos como Asunto , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/mortalidad , PronósticoRESUMEN
Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores
Asunto(s)
Humanos , Enfermedad Crítica/mortalidad , Unidades de Cuidados Intensivos , Insuficiencia Multiorgánica , Índice de Severidad de la Enfermedad , Argentina , Estudios Multicéntricos como Asunto , Insuficiencia Multiorgánica , PronósticoRESUMEN
Fueron tratados con clindamicina treinta pacientes con malaria por P. falciparum la mayoria multiquimio-resistentes. En diecinueve, la dosis fue de 20 mg/kg/peso/dia durante siete dias, por via venosa u oral.Seis recibieron la clindamicina a razon de 40 mg/kg/peso/dia venosa durante tres dias y cinco pacientes recibieron 40 mg/kg/peso/dia durante siete dias. La sintomatologia duro, en promedio 2,8 dias.Con el tratamiento la parasitemia ascendio en diecisiete pacientes y la desaparicion de la parasitemia fue, en promedio, de 5.06 dias Todos los pacientes con antecedentes malaricos con infecciones resistentes a la cloroquina y a otras drogas. Los efectos colaterales fueron minimos